Monday, August 15, 2022

Online Exposure Therapy Improves Tic Symptoms in Youth

Behavioral therapy is recommended as a first-line treatment for Tourette syndrome and chronic tic disorder, but access to treatment is limited. A study published today in JAMA Network Open points to two 10-week, therapist-supported online programs that may be able to help reduce tics in youth.

Per Andrén, Ph.D., of the Karolinska Institutet in Stockholm and colleagues recruited Swedish youth aged 9 to 17 who had been diagnosed with Tourette syndrome or chronic tic disorder for the study. A total of 221 youth and their parents were randomly assigned to online exposure and response prevention (ERP) or tic education for 10 weeks. Participants assigned to online ERP practiced tic suppression while being gradually exposed to more challenging urges (unpleasant sensations that typically precede tics). Participants assigned to online tic education were taught about Tourette syndrome, chronic tic disorder, and common comorbid disorders, as well as behavioral exercises (such as engaging in healthy habits like proper sleep and nutrition and sharing information about Tourette syndrome and chronic tic disorder with peers). Children and parents could write to the therapist at any time through the online system, and both interventions included therapist support via text messages or telephone calls, as needed.

Three months after the interventions ended, scores on the clinician-rated 50-point Total Tic Severity Score of the Yale Global Tic Severity Scale dropped 6.08 points in the ERP group and 5.29 points in the tic education group. When the youth were assessed using the Clinical Global Impression Severity and Improvement (CGI-S/I) scales, the researchers found that 47.2% of youth in the ERP group achieved treatment response (defined as a rating of “much improved” or “very much improved” on the CGI-S/I compared with 28.7% of the youth in the tic education group. Both parents and children reported higher satisfaction scores for the ERP program compared with the tic education program.

“Mean therapist support time (text messages [96%] and telephone [4%]) was 19.1 … minutes per participant and week in the ERP group and 16.6 … minutes per participant and week in the comparator group, a statistically significant difference,” the authors wrote.

“[O]ur findings suggest that both internet-delivered interventions could be implemented into regular health care to increase treatment access for children and adolescents with [Tourette syndrome] or [chronic tic disorder]. However, we would favor the implementation of ERP based on its higher treatment response rates, likely cost-effectiveness, superior working alliance, and satisfaction ratings,” they concluded.

“Most health regions experience major barriers to accessibility to behavioral [tic] therapies because of a lack of trained care professionals, long waiting times, cost, and travel distance required to see a qualified therapist,” wrote Tamara Pringsheim, M.D., of the University of Calgary and John Piacentini, Ph.D., of the University of California, Los Angeles, in an editorial accompanying the study. “The ability to use a remote delivery system with therapist support could greatly increase both acceptability and capacity for care and is a meaningful advance in the ability to provide therapeutic interventions in our field.”

They added, “This is not by any means to say that medication no longer plays a role in the treatment of [Tourette syndrome].”

To read more on this topic, see the Psychiatric News article “‘Outbreak’ of Sudden Tics Among Teen Girls Has Surprising Global Similarity.”

(Image: iStock/Alan Lerma)


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